8 Colaboración ciudadanaEstuvieron presentes desde el primer minuto ÖMuchas víctimas atendieron a otras ÖIncluso llegaron a hacer torniquetes in situ ÖSus historias son muy ricas en aspectos técnicos y humanos ÖEvacuación masiva y Scoop and run Ö xSalvaron muchas vidas y, quizá, nuestra imagenCausasGran número de heridos, algunos muy gravesRetraso inicial EMS (cuatro focos)Algunos accesos difícilesConsecuenciasDiferencias en datos EMS-SUH (en parte)Transporte no asistido de pts. gravesNo siempre fue la peor opciónBaja mortalidad in itinere (2 pacientes)Citizen’s collaboration was of critical magitude, even from the begginning.They were present from the first minute. Someone traveled in the same train. Some others were next to the focus.Gardeners, Security personnel and other City workers helped as hard as they can, even until physical and psychological extenuation.Many victims cared for the other ones. Many of them refused care in benefit of more severe wounded people.They were responsible for the Scoop and run, with variable consequences.Only two people died in car transport.A police car, arrived in the first minutes at Santa Eugenia, loaded four critical patients. One of them arrived dead at ED because of an exanguinating femoral section.The other one, a pregnant young woman, survived for ten minutes. An emergency cessarean procedure could save her baby but only for one hour.However, most of critical patients arrived at ED by this way needed initial advanced inhospital care.In our actual job, we’r trying to know if scooped patients were the least critical ISS scores in every focus, or perhaps there were some other factors for scoop as unconsciousness, heavy weight, or so.Citizens really saved a lot of lives and, perhaps, our image. They really contributed to accelerate care and evacuation.Madrid, I love you (Forges).Diferencias en el ISS ?

10 Activación 1 Unidades sanitariasDos servicios diferentes – dos Centros de Coordinación diferentes xSUMMA 112Hora punta y de relevo: doble guardiaMuchas unidades sin camilla (ej: coches rápidos)x No sistema de llamada en grupo por cualquier vía (teléf/radio/otros)Ö Se dio preferencia a enviar las unidadesx Difícil registro en tiempo realx Ausencia de software específico de catástrofesMás personal – enorme colaboraciónIncluso personal del Centro CoordinadorQuizá mayor confusión en los focos ?ÖxOur analysis begins with call receival and units immediate activation.SUMMA 112 Centre (SCU) work is nowadays subjected to some deficiencies.At 7:39 SCU begin to activate units one by one.This is not a problem in day work, but incoming call overload, the concurrence of four focus and all this work revealed the imperious need of group calls for future incidents. This problem has not been solved, yet.In this scenario, SCU operators gave preference to send units, what disturbed real-time registering tasks.As a consequence, initial activation times were not always exact, and many units’ focus specific register was mistaken.At this time, EMS is double-shifted. This won many many health workers for the job.All available additional personal was sent fo different focus on wheels. Even new teams went to focus by taxi or own cars.SAMUR even doubled workers number.Specially, at focus arrived a lot of units without inside stretcher, what became ambulances a critical factor for casualties evacuation.Ambulancias: factor críticox

12 x Cuatro focos Uno de los factores más determinantes del resultadoDifícil de preverLas unidades EMS penetraron en zonas calientes EN EVOLUCIÓNCada foco necesita un análisis individualizadocontra toda recomendación académica, sabiéndolocuando se encontraban prácticamente solasmientras la población hacía lo propioLa solución quizápueda ser difícilPerhaps, the most determinant factor of success was the presence of terrorist attacks on four different and simultaneous focus.In fact, we spent some minutes to discover this reality.In every focus, EMS teams do really penetrate in hot evolutive areas.This was accomplished even against all academic recommendations, they kew.Although this needs a more complex and internal analysis and debriefing work, we think it’s very difficult to solve it,specially when EMS units frequently were almost alone in their areas and lay people also broke security limits.Nevertheless, every focus work needs an individual advanced analysis. We show some data in next slides.

17 Atocha7:39, the first bomb explodes whit the train open-doors in a crowded station.The two bombs were separated for, at least, some seconds. When people in the same train went to help the other ones, then exploded the second bomb,Killing more people.It was horrifc for the first unit to penetrate into an area where everyone ran away from.This is what you could see in Atocha.Although Atocha PMA was placed beside a principal wall, it had to be evacuated.There was inside, at least, one relaxed patient. Some others could be evacuated in a hurry.

23 TéllezThe most complex. The first ½ hour, there was an enormous confusion.It was thought this was a train accident, and after so, perhaps the same Atocha call.The four bombs’ explosion lifted the train, at least, one meter.The train was walking, and most of the bodys broke the structure and got outside, dead.Alive victims were inside the train. Rescues were very hard. Firefighters used doors to evacuate victims.Some of them died in the first assistance.Near sports centre was used as PMA. We comment the images.

26 Datos hospitalarios Fallecidos Muy graves Críticos Heridos GravesAltasLevesAs you know, these are the official data from the same March-11 night.Datos hospitalariosConsejería de Sanidad11 de Marzo, 21 h

28 Diferentes datos EMS-SUH ¿ Por qué ?Fallecidos #Etiquetas rojasSAMUR44 – 49*1 fallecido de caminoSUMMA21* + 20**Asignaciónal azar*Fallecidos en la escena14* – 20**Caídade las comunicaciones ?Serv. Urg. Hosp.23385-90143 ?Admisible sub-triageo unidad no disponibletransporte básico?Evacuación masiva?Diferentes sistemas de clasificaciónEj: SUH críticos/muy graves/graves. No etiquetas amarillasOfficial SAMUR data talk us of patients evacuated in advanced support units. One patient died on the way.Same data of SUMMA patients show they assisted and transported a total advanced amount of patients.On scene estimations and some other data tell us about people deceased.Then, we may have a total red labels ofHospital data register 243 red labels in the first night.The, what’s the reason of these different EMS-ED data?First of all, it’s clear both have different classification systems.Second, all EMS-assisted MCI may have a legitimate sub-triage difference. Or, perhaps, no available unit.In the image on the right, we can see a green-label walking patient who received a craneotomty afterwards.Third point, data collection in focus is not always easy.Fourth, and in some instances, the most important factor –in fact, focus-dependent-, tragedy’s size and some other factors contributed to the existence of a variable people-guided scoop and run evacuation.Difícil recogida de datos en los focos* datos oficiales** estimado

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